The increasing prevalence of aortic stenosis (AS) and the increasing number of patients
indicated for transcatheter aortic valve implantation (TAVI) can lead to increased
hospital constraints. This study aimed to compare, from the hospital perspective,
the costs, resource use, and 30-day clinical outcomes of patients who underwent TAVI
under an optimized or standard clinical pathway. A single-center, retrospective study
was conducted among patients with native AS who underwent TAVI between January 2018
and March 2021. Patients who underwent optimized lean TAVI were propensity-score matched
1:1 to those who underwent standard TAVI. In-hospital costs and 30-day clinical outcomes
were compared between the 2 groups. A total of 182 patients (91 in each group) were
included in the final analysis. Baseline covariates were well balanced after matching.
Patients who underwent lean TAVI had shorter length of stay (median [interquartile
range] 3.0 days [2.0 to 6.0] vs 6.0 days [5.0 to 9.0], p <0.001). Patients in the
lean TAVI group incurred lower total costs than did those in the standard TAVI group
(mean ± SD: $41,346 ± 10,062 vs $50,471 ± 15,115, p = 0.002). There was no between-group
difference in 30-day all-cause mortality (2.2% vs 1.1%, p = 0.573) and pacemaker implantations
(5.5% vs 6.6%, p = 0.788). Rates of procedural complications were comparable between
groups. In conclusion, lean TAVI leads to hospital efficiencies without compromising
patient safety. Efforts to streamline the TAVI procedure should be encouraged to improve
access to TAVI for patients with AS, amid resource constraints.
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Article info
Publication history
Published online: November 01, 2022
Received in revised form:
September 13,
2022
Received:
June 17,
2022
Footnotes
Funding: The study was funded by Medtronic.
Identification
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© 2022 Elsevier Inc. All rights reserved.
